Healthcare Provider Details

I. General information

NPI: 1144524703
Provider Name (Legal Business Name): CAROLINA COMMUNITY SUPPORT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2010
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4324 S ALSTON AVE STE 113
DURHAM NC
27713-2696
US

IV. Provider business mailing address

4324 S ALSTON AVE STE 113
DURHAM NC
27713-2696
US

V. Phone/Fax

Practice location:
  • Phone: 919-682-5777
  • Fax: 919-687-6975
Mailing address:
  • Phone: 919-682-5777
  • Fax: 919-687-6975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: OSWALD NWOGBO
Title or Position: CEO
Credential:
Phone: 919-454-7725